Prevalence of three cardiometabolic diseases and their associated factors among patients on art at the HIV clinic in Mbale regional referral hospital.

Abstract

There are currently 1.4 million people living with HIV (PLHIV) on ART in Uganda. PLHIV are currently living longer as a result of use of antiretroviral therapy (ART). The prevalence of cardiometabolic diseases (CMDs) is increasing among this population. These diseases increase risk of development of cardiovascular disease (CVO) which is now emerging as one of the causes of morbidity and mortality ~ong PLHIV. The increased CMOs and increased GVO risk among PLHIV has been attributed to HIV infection itself, the of ARVs and shared lifestyle risk factors among others. Studies on CMOs among PLHIV in Uganda are few and those done generally been done in other parts of the country other than Mbale Regional Referral Hospital (MRRH). There is need to know the magnitude of CMDs among patients on ART in MRRH HIV clinic. The aim of this study was to determine the prevalence of CMOs and associated factors among patients on ART in MRRH.

Methods This was a cross-sectional study conducted among PLHIV in MRRH. Data was obtained from chart reviews, participant interviews and analyzed blood samples collected from the participants. Participants were systematically sampled from the ART clinic in MRRH. Odd's ratios (OR) were used as a measure of association and adjusted odds ratios (AOR) were calculated using logistic regression to explore the factors associated with CMOs. Ethical clearance was obtained from Mbale Regional Referral Hospital Research Ethics Committee.

Results A total of 324 PLHIV were included in the study, two patients had incomplete data and were excluded from analysis. Majority (63.7%) were aged between 40-59 years with mean age 45 years. There were more females (64.5%) participants than the men. Cardiometabolic diseases were prevalent in this population of PLHIV on ART with hypertension at 32.4%, dyslipidemia 50% and diabetes at 1.8%. The majority of these PLHIV were not aware of these disorders. Known traditional risk factors were associated with cardiometabolic diseases such as age above 60 years was associated with hypertension adjusted odds ratio (AOR) =9.07 (95% CL, 0.5-15), overweight (AOR = 3.59, 95% CL: 1.31- 9.88). Surprisingly patients with low salty diet were paradoxically more likely to have hypertension however most of these patients were among the 104 patients who knew their status (AOR=0.42, 95% CL: 0.2-0.90).

Dyslipidemia was strongly associated with being overweight, abnormal waist circumference, salty foods and viral load. Those with high viral load> 1000 copies had threefold increased of dyslipidemia with odds ratio (OR) = 3.46, 95% CL: 1.14-10.54). Overweight had 1.3 increased odds of being diagnosed with dyslipidemia (OR=2.26, 95% CL: 1.12- 4.59) while abnormal waist circumference had 0.7 increased odds of having dyslipidemia (OR=1.7 95% CL: 2.67). Patients who rarely added salt in their diet had increased odds of developing idernia with odds ratio (1.83, 95% CL: 1.18-2.85). Diabetes did not have any significant associations Conclusion There is higher prevalence of cardiometabolic diseases among the patients on ART in Mbale compared to the prevalence noted among the general population. A majority of the patients were not aware about their disease status. Dyslipidemia is the most prevalent followed by hypertension with diabetes the least prevalent. The traditional risk factors are associated with these diseases. The higher prevalence than in the general population suggests possible contribution of HIV to these diseases. Therefore, screening for these diseases should be emphasized among patients on ART.